Survival with Parenchymal and Pleural Invasion of Non–Small Cell Lung Cancers Less than 30 mm

Yip, Rowena; Ma, Teng; Flores, Raja M.; Yankelevitz, David F.; Henschke, Claudia I.; Salvatore, Mary M.; Wolf, Andrea; Chen, Mildred; Libby, Daniel M.; Smith, James P.; Pasmantier, Mark; Reeves, Anthony P.; Markowitz, Steven; Miller, Albert; Deval, José Cervera; Roberts, Heidi C.; Patsios, Demetris; Sone, Shusuke; Hanaoka, Takaomi; Zulueta, Javier; de-Torres, Juan P.; Lozano, Marı́a D.; Aye, Ralph W.; Manning, Kristin; Bauer, Thomas; Canitano, Stefano; Giunta, Salvatore; Cole, Enser; Klingler, Karl; Austin, John; Pearson, Gregory; Shaham, Dorith; Aylesworth, Cheryl; Meyers, Patrick R.; Andaz, Shahriyour; Vafai, Davood; Naidich, David P.; McGuinness, Georgeann; Sheppard, Barry; Rifkin, Matthew D.; Thorsen, M K; Hansen, Richard M.; Kopel, Samuel; Mayfield, William; Luedke, Dan W.; Klippenstein, Donald; Litwin, Alan; Loud, Peter A.; Kohman, Leslie J.; Scalzetti, Ernest M.; Thurer, Richard J.; Villamizar, Nestor; Khan, Arfa; Shah, Rakesh; Liu, Xueguo; Herzog, Gary; Yeh, Diana; Wu, Ning; Lowry, J.; Frumiento, Carmine; Mendelson, David S.; Smith, Michael V.; Korst, Robert J.; Taylor, Jana; Ginsberg, Michelle S.; Straznicka, Michaela; Widmann, Mark D.; Cecchi, G; Matalon, Terence A.S.; Scheinberg, Paul; Odzer, S. L.; Olsen, D.K.; Grannis, Fred; Rotter, A; Ray, Daniel; Mullen, David; Wiernik, Peter H.; Cheung, Edson H.; Lim, Melissa; DeCunzo, Louis; Glassberg, Robert; Pass, Harvey I.; Endress, Carmen; Yoder, Mark; Shah, Palmi; Welch, Laura S.; Kalafer, Michael; Green, Jeremy; Walsh, James; Bertsch, David; Camacho, Elmer; Chin, Cynthia; O’Brien, James P.; Willey, James C.

doi:10.1016/j.jtho.2019.01.013

Cited by 28 publications

(7 citation statements)

References 43 publications

(69 reference statements)

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“…More important, our daily practice clearly demonstrates a new issue that radiologic pure-solid lung cancers without a GGO component exhibit a more malignant behavior with regard to both the clinical and pathological aspects, and show several histologic types that have a poorer prognosis than radiologic part-solid lung cancer. [9][10][11][12][23][24][25][26][27][28] Although this concept has not been fully studied on a nationwide level, a clinical implication of this analysis was that a significant Japanese center validation demonstrated a favorable prognosis of part-solid lung adenocarcinoma in the prospective JCOG0201 dataset, which is irrespective of the solid component size in cases in which the tumor showed a GGO component. This notion is completely different from known information on lung cancer with a part-solid component.…”

Section: Discussionmentioning

confidence: 97%

Prognostic impact of a ground-glass opacity component in clinical stage IA non–small cell lung cancer

Hattori

Suzuki

Takamochi

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

104

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Objective: We performed a validation study to confirm the prognostic importance of the presence of a ground-glass opacity component based on data of the Japan Clinical Oncology Group study, JCOG0201, which was a prospective observational study to predict the pathological noninvasiveness of clinical stage IA lung cancer in Japan.Methods: Among the 811 patients registered in JCOG0201, 671 were confirmed eligible by study monitoring and a central review of computed tomography. Registered c-stage IA lung cancer was less than 30 mm in maximum tumor size, which was classified into a with ground-glass opacity group (pure ground-glass opacity and part-solid tumor) or solid group based on the status of a ground-glass opacity component. T staging was reassigned in accordance with the 8th edition of the TNM staging system. To validate the prognostic impact, overall survival was estimated.Results: Of the cases, 432 (64%) were in the with ground-glass opacity group and 239 (36%) were in the solid group with a median follow-up time of 10.1 years. The 5-year overall survival was significantly different between the with ground-glass opacity group and solid group (95.1% vs 81.1%). The 5-year overall survival was excellent regardless of the solid component size in the with ground-glass opacity group (c-T1a or less: 97.2%, c-T1b: 93.4%, c-T1c: 91.7%). In contrast, prognostic impact of the tumor size was definitive in the solid group (c-T1a: 87.5%, c-T1b: 85.9%, c-T1c: 73.7%).Conclusions: Favorable prognostic impact of the presence of a ground-glass opacity component was demonstrated in JCOG0201. The presence or absence of a ground-glass opacity should be considered as an important parameter in the next clinical T classification.

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Section: Discussionmentioning

confidence: 97%

Prognostic impact of a ground-glass opacity component in clinical stage IA non–small cell lung cancer

Hattori

Suzuki

Takamochi

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

104

View full text Add to dashboard Cite

show abstract

“…However, their study, a singlecenter, retrospective review, was limited to a small sample size and few outcome events, which might have affected the performance of regression modeling and could have led to misleading results (25)(26)(27). In addition, their study did not distinguish VPI from lymphovascular invasion, which is also a poor prognostic feature of small-sized NSCLC and might have a simultaneous effect on VPI (9,28).…”

Section: Discussionmentioning

confidence: 97%

“…However, controversy still remains about the impact of VPI on the choice of surgical treatment for early-stage NSCLC with VPI. Several prior retrospective studies included only small-sample, single-institution cases, which were subject to selection bias (9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Sublobectomy versus lobectomy for long-term survival outcomes of early-stage non-small cell lung cancer with a tumor size ≤2 cm accompanied by visceral pleural invasion: a SEER population-based study

Huang

Wang

et al. 2020

J Thorac Dis

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Background: The optimal surgical strategy for early-stage non-small cell lung cancer (NSCLC) with visceral pleural invasion (VPI) remains unclear. Due to limited prospective comparative data for these surgical modalities, the objective of the current study was to compare the long-term survival outcomes of sublobectomy (Sub) versus lobectomy (Lob) for NSCLC with a tumor size ≤2 cm and VPI. Methods: Patients with early-stage NSCLC characterized by VPI diagnosed between 2004 and 2013 were identified from the Surveillance, Epidemiology, and End Results (SEER) program. The baseline demographic and cancer characteristics, treatment information as well as survival outcome data were extracted from the SEER database, and confounders were balanced by propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses. Lung disease-specific survival (DSS) and overall survival (OS) rates were compared with Cox proportional hazards (PH) regression models based on the unmatched cohort, the propensity-based matched cohort, and the IPTW cohort. Results: Of the 1,386 patients enrolled, 1,000 (72.15%) and 386 (27.85%) underwent lobectomy and sublobectomy, respectively. The 5-year DSS rate was 78.64% for the lobectomy group and 59.47% for the sublobectomy group. Cox regression models demonstrated that the operation type (Sub vs. Lob) was an independent prognostic factor for early-stage NSCLC with VPI based on the three different cohorts.Patients who underwent lobectomy showed better long-term DSS and OS rates than those treated with sublobectomy after PSM [DSS: hazard ratio (HR) 0.689, 95% confidence interval (CI): 0.490-0.968, P=0.032; OS: HR 0.723, 95% CI: 0.549-0.953, P=0.021]. The IPTW analysis yielded similar results. Conclusions: Lobectomy showed superior long-term survival compared with sublobectomy in patients with early-stage NSCLC with a tumor size ≤2 cm and VPI.

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“…The reason for not distinguishing between histological types is that nodule consistency on CT is a more significant prognostic indicator than either pleural invasion or parenchymal invasion (angiolymphatic and/or vascular). Lung adenocarcinomas that appear as subsolid or nonsolid, have a much better prognosis than that of lung adenocarcinomas manifesting as SNs (31)(32)(33). Second, doctors had access to clinical information and prior images, which were especially beneficial for diagnosing metastases, but the AI did not have access to this information.…”

Section: Discussionmentioning

confidence: 99%

Assessing the predictive accuracy of lung cancer, metastases, and benign lesions using an artificial intelligence-driven computer aided diagnosis system

Li¹,

Liu²,

Zhong³

et al. 2021

Quant Imaging Med Surg

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Background: Artificial intelligence (AI) products have been widely used for the clinical detection of primary lung tumors. However, their performance and accuracy in risk prediction for metastases or benign lesions remain underexplored. This study evaluated the accuracy of an AI-driven commercial computer-aided detection (CAD) product (InferRead CT Lung Research, ICLR) in malignancy risk prediction using a realworld database.Methods: This retrospective study assessed 486 consecutive resected lung lesions, including 320 adenocarcinomas, 40 other malignancies, 55 metastases, and 71 benign lesions, from September 2015 to November 2018. The malignancy risk probability of each lesion was obtained using the ICLR software based on a 3D convolutional neural network (CNN) with DenseNet architecture as a backbone (without clinical data). Two resident doctors independently graded each lesion using patient clinical history. One doctor (R1) has 3 years of chest radiology experience, and the other doctor (R2) has 3 years of general radiology experience. Cochran's Q test was used to assess the performances of the AI compared to the radiologists. Results:The accuracy of malignancy-risk prediction using the ICLR for adenocarcinomas, other malignancies, metastases, and benign lesions was 93.4% (299/320), 95.0% (38/40), 50.9% (28/55), and 40.8% (29/71), respectively. The accuracy was significantly higher in adenocarcinomas and other malignancies compared to metastases and benign lesions (all P<0.05). The overall accuracy of risk prediction for R1 was 93.6% (455/486) and 87.4% for R2 (425/486), both of which were higher than the 81.1% accuracy obtained with the ICLR (394/486) (R1 vs. ICLR: P<0.001; R2 vs. ICLR: P=0.001), especially in assessing the risk of metastases (P<0.05). R1 performed better than R2 at risk prediction (P=0.001). Conclusions:The accuracy of the ICLR for risk prediction is very high for primary lung cancers but poor for metastases and benign lesions.

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Survival with Parenchymal and Pleural Invasion of Non–Small Cell Lung Cancers Less than 30 mm

Cited by 28 publications

References 43 publications

Prognostic impact of a ground-glass opacity component in clinical stage IA non–small cell lung cancer

Prognostic impact of a ground-glass opacity component in clinical stage IA non–small cell lung cancer

Sublobectomy versus lobectomy for long-term survival outcomes of early-stage non-small cell lung cancer with a tumor size ≤2 cm accompanied by visceral pleural invasion: a SEER population-based study

Assessing the predictive accuracy of lung cancer, metastases, and benign lesions using an artificial intelligence-driven computer aided diagnosis system

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